Esmolol blunts postoperative hemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanesthesia for intracranial surgery.
OBJECTIVE
To investigate whether esmolol is effective in attenuating postoperative hemodynamic changes related to sympathetic overdrive.


METHODS
Clinical study.


METHODS
Operating room of a university hospital.


METHODS
60 ASA physical status I, II, and III patients, age 18 to 65 years, scheduled for elective craniotomy for supratentorial neurosurgery.


METHODS
Patients were given total intravenous anesthesia (TIVA) during emergence from anesthesia and up to 60 minutes after extubation. Those patients who had hypertension (defined as an increase in systolic blood pressure >20% from baseline values) and tachycardia (defined as an increase >20% in heart rate from baseline) received a loading dose of 500 microg/kg esmolol in one minute, followed by an infusion titrated stepwise (50, 100, 200, and 300 microg/kg per min) every two minutes.


METHODS
The mean dose and duration of esmolol therapy were measured.


RESULTS
Of 60 patients, 49 (82%) who received propofol-remifentanil TIVA developed significant tachycardia and hypertension soon after extubation. Treatment with esmolol (500 microg/kg in bolus maintained at a mean rate of 200 +/- 50 microg/kg per min) effectively controlled hypertension and tachycardia in 45 of 49 patients (92%; P < 0.05) within a mean 4.30 +/- 2.20 minutes. After extubation, mean esmolol infusion time was 29 +/- 8 minutes.


CONCLUSIONS
In patients undergoing elective neurosurgery with propofol-remifentanil TIVA, a relatively small esmolol dose and short infusion time effectively blunts early postoperative arterial hypertension and tachycardia.
Bilotta
Federico
F
Department of Anesthesia, Intensive Care, and Pain Medicine, University of Rome "La Sapienza," Rome, Italy. bilotta@tiscali.it
Lam
Arthur M
AM
Doronzio
Andrea
A
Cuzzone
Vincenzo
V
Delfini
Roberto
R
Rosa
Giovanni
G
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D003399:Craniotomy / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data; D010880:Piperidines; D011183:Postoperative Complications / Q000517:prevention & control*; D011412:Propanolamines / Q000627:therapeutic use*; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D018686:Anesthetics, Intravenous; D010880:Piperidines; D011412:Propanolamines; C036604:esmolol; D000077208:Remifentanil; D015742:Propofol